非小细胞肺癌的医保政策的回顾性研究与现状分析
A Retrospective Study and Current Situation Analysis of Medical Insurance Policies for Non-Small Cell Lung Cancer

目的：2022年国家癌症中心发布的最新一期的全国癌症统计数据显示，2016年我国新发癌症病例达到406.4万，整体癌症粗发病率仍持续上升，肺癌患病率仍在所有癌种中居于高位。近年来，免疫治疗的推广，靶向药物的研发，国家基本医保、工伤保险和生育保险的药品目录(后文一并简称“医保目录”)的更新给患者带来了经济负担减轻与治愈的希望，同时也为我国基本医疗保险制度的完善、医疗资源的利用与医疗保险基金的持续发展带来更多挑战。方法：本论文主要基于非小细胞肺癌(Non-Small Cell Lung Cancer, NSCLC)的病例，通过整理临床病例，分析治疗方案，运用经济性评价与政策视角总结我国医保制度发展，并以综合视角分析肺癌患者以及社会的经济负担。结果：医保报销水平的提高往往带来自付比例的下降，但也会给我国医保控费带来更大压力。结论：国家医保政策体系和医保目录从政策方面发力，减少了“有药可医却无钱治病”的状况，但对医疗资源与资金进行合理配置仍需要科学的计算与统筹。
Objective: According to the latest national cancer statistics released by the National Cancer Center in 2022, the number of new cancer cases in China reached 4,064 million in 2016, the overall crude cancer incidence rate continued to rise, and the prevalence rate of lung cancer was still high among all types of cancer. In recent years, the promotion of immunotherapy, the research and development of targeted drugs, and the updating of the drug list of national basic medical insurance, industrial injury insurance and maternity insurance (hereafter referred to as “medical insurance list”) have brought the hope of reducing the economic burden and healing for patients, but also brought more challenges for the improvement of basic medical insurance system, the utilization of medical resources and the sustainable development of medical insurance funds. Methods: This paper is mainly based on the cases of Non-Small Cell Lung Cancer (NSCLC), by sorting out clinical cases, analyzing treatment plans, using economic evaluation and policy perspectives to summarize the development of Chinese health insurance system, and analyze the patients of lung cancer and the economic burden of society from a comprehensive perspective. Result: The improvement of medical insurance reimbursement often leads to a decrease in the proportion of out-of-pocket payments, but also brings greater pressure to the control of medical insurance costs. Conclusion: The national medical insurance policy system and the medical insurance catalog have exerted their strength from the policy aspect, reducing the situation of “having medicine but not having money to cure”, but rationally allocating the medical resources and funds still needs scientific calculation and coordination.